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The Mind > Substance Use/abuse > Flashcards

Substance Use/abuse Flashcards

0
Q

Substance abuse epi

A
  • more common in men
  • in general lower income good predictor (alcohol abuse more common in educated urban)
  • script opioids and heroine
  • of co-morbid conditions, anti-social personality disorder 80%
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1
Q

Most common illicit drug

A

Cannabis

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2
Q

Biology of addiction

A
  • dopaminergic
  • nucleus acumbens
  • social attachments: loners, distant from parents, abuse all increase
  • rapid onset = more addicting (greater high)
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3
Q

ALDH2

A
  • polymorphism resulting in lower alcohol metabolism (less alc dehyd)
  • worse hangovers
  • associated with lower rates of alcoholism; higher metabolic rates assoc with hire alcoholism
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4
Q

Alcohol cross tolerance

A

Benzos
Barbiturates
- all three withdrawal can kill you

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5
Q

AST/ALT

A
  • last call for alcohol: 21 typical ratio in suspected EtOH: 2/1
  • in general enzymes all increase, ions/nutrients decrease
  • thiamin BEFORE glucose
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6
Q

CDT (carbohydrate deficient transferrin)

A
  • highly sensitive and specific for excessive EtOH consumption
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7
Q

GGT (and false positive)

A
  • fairly specific for alcohol abuse

- not very good for detecting relapse and can be elevated by ibuprofen, phenobarbital, and Dilantin

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8
Q

MCV (mean corpuscular volume)

A
  • large RBCs due to malnutrition and due to alcohols toxic effect on marrow
  • combined GGT and MCV are highly suggestive of alcohol abuse
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9
Q

Depressant effect of alcohol

A
  • initially may produce euphoria

- eventually depresses CNS and psychological worsens psychological depression

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10
Q

Wernicke-korsakoff

A
  • wernickies: more acute phase
    ~ opthalmoplegia; nystagmus, Diplopia
    ~ ataxia
    ~ memory impairment, apathy (confused state)
    ~ 90% progress from wernickies to Korsakoffs
  • Korsakoffs: chronic effects
    ~ degeneration of mammillary bodies, hypothalamus
    > loss of STM, confabulation
  • TREAT: thiamin before glucose (be generous with treatment)
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11
Q

Alcohol withdrawal (time frame)

A
  • begins 6-8 hours, peaks at 24-48, resolves at 4-5 days

- severe symptoms are uncommon (5%)

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12
Q

Complicated EtOH withdrawal

A
  • usually includes hallucinations (usually auditory, visual and tactile rare but possible)
  • occurs in presence of clear sensorium
  • last ~ 1 week
  • non-life threatening
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13
Q

EtOH withdrawal seizures

A
  • 6-48 hours after last drink
  • usually tonic-clonic (can progress to status epilepticus)
  • benzos first line
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14
Q

Delirium tremens

A
  • life threatening
  • normal withdrawal, includes delirium and autonomic dysfunction
  • supportive care, potentially sedation and seclusion
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15
Q

Uncomplicated withdrawal: 4 primary symptoms

A
  • dysrythmia
  • pancreatitis
  • TB
  • GI bleeds
  • treat early and often w/ thiamin and folate
16
Q

Complicated withdrawal trt

A
  • Valium load 20mg q hour x3 or till they sleep

- diazepam (valium)/ chlorodiazepoxide (Librium) long acting preferred except in elderly (use oxazepam or lorazepam)

17
Q

Addiction treatment

A
  • disulfiram: aversive (NO EtOH -> instant severe hangover)
  • naltrexone: not in liver dysfunction (monitor lfts), can precipitate withdrawal
  • acamprosate: hig dose = poor compliance; safe in liver dysfunction
  • topiramate: lots if mood/metabolic side effect
18
Q

Benzo intox/withdrawal

A
  • benzos are EtOH in a pill
  • OD with benzos rarely fatal, combo mush more dangerous
  • effects are similar: day 1- anxious, restless, coarse tremor and auto hyper-arousal; day 2-3: seizures
19
Q

Withdrawal trt: benzos, barbs, EtOH

A
  • barbiturates: trt with barbs
  • benzos: trt with benzos or barbs
  • EtOH: trt with all three
20
Q

Opiate addiction

A
  • withdrawal rarely fatal, only in infants
  • OD can be fatal
  • most common in antisocial personality disorder
  • relapse rates really high
  • opiates mixed effect, but primarily parasympathetic
  • respiratory depression danger/fatality
21
Q

Opiate withdrawal/OD

A 
- OD is hypercholinergic effect 
   ~ main issue is airway protection 
   ~ naxalone -> withdrawal 
- withdrawal is anticholinergics effect 
   ~ symptomatic trt: 
    > Clonadine: autonomic symptoms
    > Benadryl: rhinorrhea/itching
    > NSAIDs: pain
    > promethazine: N/V
    > loperamide: diarrhea/cramps 
- methadone for chronic trt (bupropion alternative)
22
Q

Consideration when using naltrexone

A
  • Pt must be opioid free for 7 days to avoid withdrawal
23
Q

Meth v. Cocaine

A
  • meth:
    ~ man made, blocks reuptake and induces release, 8-24 hr 1/2L, neurotoxic in chronic users
  • cocaine:
    ~ natural, only blocks reuptake, 23-30 minute high, 1 hour 1/2L, no evidence of neurotoxicity
24
Q
  • tachycardia
  • HTN
  • mydriasis
  • diaphoresis
  • NV
  • anorexia
  • psychomotor agitation
  • transient psychosis
  • hypersexuality
  • bruxism
A

Stimulant intoxication

25
Q
  • anxiety
  • dysphoria
  • lethargy/fatigue
  • HA
  • muscle cramps
  • hunger
  • profuse sweating
A

Stimulant withdrawal

26
Q

Stimulant treatment

A
  • usually withdrawal/OD is self limiting

- symptomatic trt: benzos for agitation, antipsychotics for psychosis

27
Q

Hallucinogens effects

A
  • Sympathomemetic effect
  • bad trips can be permanent in chronic users
  • anticipating bad trip -> more likely
28
Q

Hallucinogen e.g.

A
  • LSD: rapid onset, synesthesia
  • MDMA: (ex) strong feelings of attachment, euphoria, altered time perception, hyperpyrexia (esp with PMA and PMMA)
  • PCP: dangerous, vertical nystagmus (can cause horizontal nystagmus but vertical is sp. for PCP) 30 minute peak, aggression,
29
Q

PCP trt

A
  • benzos/antipsychotics: agitation
  • phentolamine: for HTN
  • hydration (rhabdo is significant risk)
  • excretion most effective trt: acidifying, diuretics
30
Q

Cannabis

A
  • red eyes, dry mouth, munchies, ortho HoTN, tachy, depersonalization/derealization, psychosis, euphoria
  • amotivational syndrome
  • withdrawal may or may not exist: benzos for anxiety
31
Q

Accelerant issues

A
  • only one to cause heavy metal poisoning, NM tox, brain damage
  • can cause sudden death from arrythmias
  • resp. Comp, immun. comp
32
Q

Nicotine dependance/withdrawal/trt (timeframe)

A
  • dependance is essentially the necessary conclusion
  • withdrawal: 1 hour after last cigarette, peaks at 24 can last weeks/months
  • trt: replacement, intervention: bupropion, varenicline anti-NM receptor
33
Q

Caffeine considerations (lethality, co-morbidities)

A
  • greater that 1g/day can put you in coma
  • associated with co-morbidities in chronic use
    ~ HTN, exacerbation of fibrocystic disease in women
    ~ anxiety
34
Q

fibrocystic disease in women

A
  • co-morbidity of nicotine use

The Mind (7 decks)

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